A Comparison of Three Silver-containing Dressings in the Treatment of Infected, Chronic Wounds

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Author(s): 
Manuel Gago, MSc; Fernando Garcia, RN; Victoriana Gaztelu, PhD; Jose Verdu, PhD; Pablo Lopez, MScN; Andreu Nolasco, PhD

Address correspondence to:
Jose Verdu, PhD
University of Alicante
Ap. De Correos, 99
03080, Alicante
Spain
Phone: 0034 64 997 8317
E-mail: pepe.verdu@ua.es




Abstract: Objective. To compare 3 types of silver dressing in the typical clinical conditions of a community health center, regarding the time to achieve resolution of clinical signs of local infection, and wound healing progress over 8 weeks. Methods. A prospective, comparative study involving 75 patients with infected chronic wounds who were divided into 3 treatment groups: Acticoat™ (group 1); Comfeel® Ag hydrocolloid/Biatain® Ag polyurethane foam (group 2); and Aquacel® Ag (group 3). Results. The groups were comparable at baseline. Clinical signs of infection were resolved faster in group 1 than in the other two groups (P < 0.05, median: group 1 = 2 weeks; group 2 = 4 weeks; group 3 = 4 weeks. Group 1 required fewer treatments to eliminate the clinical signs of infection (median: group 1 = 6 treatments; group 2 = 12 treatments; group 3 = 12 treatments). Patients in group 1 healed faster than patients in the other 2 groups (P < 0.05). Conclusion. The treatment in group 1 was more effective than that of groups 2 and 3 in the treatment of infected, chronic wounds. Clinical signs of infection were resolved faster (P < 0.05) and wounds healed more quickly (P < 0.05) in group 1 than in the other 2 groups.


   The majority of chronic wounds, typically up to 70%, can be healed within 12 to 24 weeks, but this still leaves a considerable proportion that heal with difficulty, even when advanced techniques are used.1 Although it has been shown that the presence of low levels of bacteria can actually enhance wound healing, the healing process is undoubtedly affected by the presence of high levels of bacteria—wounds can be colonized without showing any signs or symptoms of infection, and with little effect on healing, apart from a delay in healing time.2 However, clinical infection will affect wound healing and often prevents closure.3

   Various antimicrobial products are available for bacterial load management, and there is significant variability in clinical practice regarding product selection. Choosing the correct antimicrobial dressing has become a significant challenge.4 It is necessary to improve the diagnosis of infection in order to use these dressings correctly.5

   Silver is bactericidal against a large number of Gram-positive and Gram-negative micro-organisms, both aerobic and anaerobic, and against several multi-resistant microorganisms.6,7 Currently, there are more than 10 silver dressings on the market,8 each with different formulations (creams, foams, hydrogels, hydrocolloids, polymer films and meshes). Each formulation offers different advantages,9 some require a secondary gauze dressing or a treatment in a moist environment, while others act as a secondary dressing. Also, great differences exist with respect to clinical efficacy. It is important to understand whether the action of the dressing is that of a true antimicrobial intervention within the wound environment, or whether the level of silver is only sufficient to keep the dressing “microbiologically clean.”

   The activity of a silver-containing dressing is related to the amount, type, and distribution of silver in the dressing.8–10 Studies suggest that the antimicrobial activity of silver improves healing,7 but actual research findings are inconclusive or contradictory.6,7,9,11 Many of these are in-vitro studies or use animal models; clinical trials are only now beginning to appear. No other studies were found that compare different silver dressings in the treatment of chronic wounds.

References: 

1. EWMA (European Wound Management Association) Position Document: Wound Bed Preparation in Practice. London: MEP Ltd; 2004.
2. Dow G, Browne A, Sibbald RG. Infection in chronic wounds: controversies in diagnosis and treatment. Ostomy Wound Manage. 1999;45(8):23–40.
3. Ovington L. Bacterial toxins and wound healing. Ostomy Wound Manage. 2003;49(7A Suppl):8–12.
4. Stephen-Haynes J, Toner L. Assessment and management of wound infection: the role of silver. Br J Community Nurs. 2007;12(3):S6–S12.
5. EWMA (European Wound Management Association). Position Document: Identifying Criteria for Wound Infection. London: MEP Ltd; 2005.
6. Hermans MH. Silver-containing dressings and the need for evidence. Am J Nurs. 2006;106(12):60–68.
7. Verdú J, Lopez P, Fuentes G, Torra J. Apósitos que contienen plata. Revisión sistemática acerca de sus evidencias. V Simposio Nacional sobre Ulceras por Presión y Heridas Crónicas; Oviedo, Spain; 2004.
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9. Leaper DJ. Silver dressings: their role in wound management. Int Wound J. 2006;3(4):282–294.
10. Ovington LG. The truth about silver. Ostomy Wound Manage. 2004;50(9A Suppl):1–10.
11. Vermeulen H, van Hattem JM, Storm-Versloot MN, Ubbink DT. Topical silver for treating infected wounds. Cochrane Database Syst Rev. 2007;24(1):CD005486.
12. Münter KC, Beele H, Russell L, et al. Effect of a sustained silver-releasing dressing on ulcers with delayed healing: the CONTOP study. J Wound Care. 2006;15(5):199–206.
13. EWMA (European Wound Management Association). Position Document: Management of Wound Infection. London: MEP Ltd; 2006.
14. van Rijswijk L. Full-thickness leg ulcers: patient demographics and predictors of healing. Multi-Center Leg Ulcer Study Group. J Fam Pract. 1993;36(6):625–632.
15. Arnold TE, Stanley JC, Fellows EP, et al. Prospective, multicenter study of managing lower extremity venous ulcers. Ann Vasc Surg. 1994;8(4):356–362.
16. van Rijswijk L, Polansky M. Predictors of time to healing deep pressure ulcers. Ostomy Wound Manage. 1994;40(8):40–48.
17. Sibbald RG, Contreras-Ruiz J, Coutts P, Fierheller M, Rothman A, Woo K. Bacteriology, inflammation, and healing: a study of nanocrystalline silver dressings in chronic venous leg ulcers. Adv Skin Wound Care. 2007;20(10):549–558.
18. McCaule L, Spruce P, Searle R. An audit of silver dressings in leg ulcer management. Poster presented at: Wounds UK Conference; November 2007; Harrogate, UK.


















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